Low back pain in adults: early management

  

This guideline is about the care and treatment that people who have persistent non-specific low back pain can expect from the NHS in England and Wales to help them manage their pain.

Non-specific low back pain is caused by problems with structures in the back, such as joints, discs, muscles, tendons or ligaments. The guideline covers the management of pain that has lasted for longer than 6 weeks but less than a year.

This information explains the advice about the early management of persistent non-specific low back pain that is set out in NICE clinical guideline 88.

'Non-specific' low back pain is caused by problems with structures in the back, such as the joints, discs, muscles, tendons and ligaments. This type of back pain is not caused by cancer, infection, a fracture or an inflammatory disorder – these conditions are responsible for only a very few cases of persistent low back pain.

The NICE guideline defines 'persistent' low back pain as pain that has lasted for longer than 6 weeks but less than a year.

It can be difficult to completely cure non-specific low back pain, and treatments are usually aimed at helping people manage their condition.


This guideline is currently being updated. Further information can be found on the low back pain (update) page.

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Ketamine Infusion May Be Adjunct Sedative Alternative To Benzodiazepines in Mechanically Ventilated ICU Patients

 

Continuous ketamine infusion may be a safe and effective adjunct to sedation in mechanically ventilated critically ill patients, and could be a potential alternative to the continuous infusion of benzodiazepines.

“Ketamine is a rapid-acting anesthetic with both sedative and analgesic properties,” said Lara Groetzinger, PharmD, of the medical ICU of the University of Pittsburgh Medical Center’s Presbyterian Hospital, and the lead researcher.

“Its unique mechanism of action provides an option for patients who are mechanically ventilated and require both sedation and analgesia.” The study was presented at the Society of Critical Care Medicine’s 2016 Critical Care Congress (abstract 586).

Dr. Groetzinger said continuous infusion of benzodiazepines has been associated with negative outcomes, such as increased duration of mechanical ventilation and ICU length of stay, possibly related to the deep sedation and delirium associated with these agents.

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11 Chronic Pain Control Techniques

To prepare for any chronic pain coping technique, it is important to learn how to use focus and deep breathing to relax the body. Learning to relax takes practice, especially when you are in pain, but it is definitely worth it to be able to release muscle tension throughout the body and start to remove attention from the pain.
Coping techniques for chronic pain begin with controlled deep breathing, as follows:

• Try putting yourself in a relaxed, reclining position in a dark room. Either shut your eyes or focus on a point.
• Then begin to slow down your breathing. Breathe deeply, using your chest. If you find your mind wandering or you are distracted, then think of a word, such as the word "Relax," and think it in time with your breathing...the syllable "re" as you breathe in and "lax" as you breathe out.
• Continue with about 2 to 3 minutes of controlled breathing.
• Once you feel yourself slowing down, you can begin to use imagery techniques.

Eleven specific imagery and chronic pain control techniques that are effective for pain control include:
Altered focus, Dissociation, Sensory splitting, Mental anesthesia ...

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Source: Spine-health

Giving Tramadol? Check That Glucose Reading!

 

By Marie Rosenthal

Tramadol lowers blood glucose levels in diabetic and nondiabetic patients, according to a poster (poster 19-M) presented at the ASHP Summer Meetings in Baltimore, and health care providers should consider glucose monitoring in patients who take the pain medication.

 Tramadol, an opioid, changes the way the brain perceives pain by inhibiting serotonin and norepinephrine reuptake. It also activates opioid receptors that further inhibit painful effects. Both of these actions inhibit glucose, Larry Golightly, PharmD, a medication-use evaluation/adverse drug reaction coordinator at University of Colorado Hospital, in Aurora, explained in an interview with David Bronstein, editorial director of Pharmacy Practice News.

There have been reports of patients taking tramadol for pain requiring hospitalization because of these glucose-lowering effects, according to Dr. Golightly. “Although it is not common, their blood glucose can go low enough that they require hospitalization,” he said. 

Acupuncture Relieves Post-Stroke Anxiety & Depression

Acupuncture relieves anxiety and depression experienced by stroke patients. Researchers from the Shanghai University of TCM (Traditional Chinese Medicine) investigated the efficacy of acupuncture and medications for the treatment of post-stroke anxiety and depression. The SSRI (serotonin reuptake inhibitor) drug sertraline demonstrated a 73.3% total efficacy rate. Conventional acupuncture achieved an 80% total effective rate. Another group received a treatment protocol of Sun Si-Miao’s ghost acupoints combined with sertraline. The combination group achieved a 93.3% total effective rate. The researchers concluded that the combination of acupuncture with drug therapy is safe and effective for the treatment of anxiety and depression due to post-stroke syndrome.

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Practice Guidelines for Obstetric Anesthesia

An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology

 PRACTICE guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to the clinical needs and constraints and are not intended to replace local institutional policies. In addition, practice guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their
use cannot guarantee any specific outcome. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open-forum commentary, and clinical feasibility data.

This document updates the “Practice Guidelines for Obstetric Anesthesia: An Updated Report by the ASA Task Force on Obstetric Anesthesia,” adopted by ASA in 2006 and published in 2007.

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Guidelines Updated for Optimal Perioperative Geriatric Care

Extensive updates to best-practice recommendations for the perioperative care of patients 65 years of age and older have just been released; anesthesiologists take note.

“Optimal Perioperative Management of the Geriatric Patient: A Best Practices Guideline,” provides a management checklist for anesthesiologists and other medical professionals when caring for older patients facing surgery.

The guidelines cover the use of anesthesia and perioperative analgesia in older patients. Best practices for dealing with perioperative nausea and vomiting, preventing postoperative complications including hypothermia and fluid management are also detailed.

Acupuncture with TCM Benefits Muscular Dystrophy Patients

While groundbreaking discoveries rooted in the laboratory are making progress in treating children with Duchenne muscular dystrophy (DMD), acupuncture and Traditional Chinese Medicine (TCM) also hold potential to help alleviate symptoms and enhance muscle function. A team of researchers combined a number of alternative therapies along with drug therapy to create a treatment regimen for DMD patients. During the study, the regimen resulted in a significant improvement in physical function and reduced inflammation in the patients’ bodies.

The research team enrolled 60 pediatric DMD patients at the Neurology and Rehabilitation Department at Zhengzhou Children’s Hospital. Upon enrollment, patients were divided into treatment and drug-only groups. The treatment group received acupuncture, far infrared therapy, TCM tuina massage, herbal medicine, and drug therapy, while the drug-only group received drug therapy alone. Treatment lasted for a total of two years.

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Checklists – As Important As Ever in Anesthesia Patient Safety

The concept of the safety checklist is simple and well-established, but compliance varies widely.  Some of the keys to successful implementation are extensive preparation to maximize safety culture in the unit where checklists are to be used, engagement of leadership in rolling out and emphasizing the importance of the checklist, and customization to the specific hospital.

“Patient Safety Issues Spur NIH Shake-Up” was an above-the-fold headline in the Washington Post on May 11, 2016.  NIH Director Francis Collins, MD is replacing top leadership at the 200-bed Clinical Center with a new management team with experience in oversight, compliance and patient safety in the wake of an independent review that found that safety had become “subservient to research demands.”

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Evidence-Based Guidelines for Management of Post-Op Pain Issued Jointly by APS, ASA and ASRA

 

 

The American Pain Society, for the first time, has released a clinical practice guideline on managing postoperative pain.

The guideline was created with input from the American Society of Anesthesiologists (ASA) and was subsequently approved by the American Society for Regional Anesthesia and Pain Medicine (ASRA), and was based on the 23-member panel’s review of 6,500 scientific abstracts and primary studies.

Acupuncture Alleviates Knee Pain Due to Arthritis

Acupuncture relieves pain, stiffness, and improves knee function for patients with knee osteoarthritis. Researchers from the Chengdu University of TCM (Traditional Chinese Medicine) investigated the efficacy of acupuncture and Tui Na massage for the treatment of knee osteoarthritis. Two groups were compared. Group 1 received only acupuncture and group 2 received a combination of acupuncture and Tui Na massage. Both groups yielded significant positive patient outcomes. The group that received the combined acupuncture and Tui Na care outperformed the acupuncture standalone care group.

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Novel Non-invasive Monitor Accurately Assesses Patients’ Response to Painful Stimulation During Surgery, Study Finds

A novel measure for assessing the body’s response to surgery may allow for better anesthesia management in the O.R., less pain when regaining consciousness from anesthesia and better postoperative outcomes.  According to a study published in the Online First edition of Anesthesiology, the official medical journal of the American Society of Anesthesiologists (ASA), the measure, called the nociception (pain) level index, allowed physicians to more accurately evaluate responses to painful stimulation in patients under general anesthesia, compared to traditional measures. 

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